i= sq;
<br /> r k u � r s � 1 � wh-,w�4'S=5 sY x . � 3»-,...i,� r r '✓'�k
<br /> g
<br />��F yV cam`
<br /> yCHAIN OF CUSTODY:,RECORD�
<br /> r �-Advanced; _'i ���
<br /> "krd fix, � s, t � Wi C s,< rF,� s,
<br /> t- _ ,' sit "' x r . Date S� Page of
<br /> --- ° .3GeoEnvironmentaL nc.
<br /> �-r'Y�
<br /> X4�005�N's' W'1 Cr a+li.fo°.bmia 9,r52�05 (209)467-1006-Fax(209)467-111 B .}�rrrrtcy-S ,
<br /> Imo ^
<br /> �r�1��ta,��;� ;��.�:r','..�S_-.,�.Yi;Y/a-swA�_3�wt-a✓x..y,...-.,rfi..ry„,'"t.T�TK,y"Ti�ro'.�;�l"`r�i F..-�s�le 6` ��w'��:�7�<_'+ �w'"_�'�ov�' i � �
<br /> _ProjecManager
<br /> 4:-7cteTests Requiedi t� Tr rt! // V
<br /> � N.
<br /> Nr. " Phone Number 4
<br /> ,L(/ 7 - IOU
<br /> P i + " Y "v
<br /> �a�� Y�$ s �' '; („ �zx SMF' a-- fr1 } �� ty, K a
<br /> �y A _,_.-� Y 4 Ms ydr�-� f '�� Y Samplers (Signature) 4 , i`nvolce� , �
<br /> "f •Y { ''„* ' ";+ { � r� �,AGE
<br /> ' },p0)eCt`Nam$� Cllent� ,r+
<br /> .k _ � r Sample Type
<br /> k Sample'` `a .,Location �' R No of �s `�'
<br /> { ra. = r. Date Time Water Solid �� t, _„ �r`�p Nates I Vis. �3= r
<br /> °' � Nurnber' , a~ Descnptlon ' Air Cants �q
<br /> ; Comp Grab �.3': .. ;.s^
<br /> {/
<br /> p „ f , 4`_r.fr/f`� L},N i > i !-�[
<br /> t. L; t' ��,.ia �} '` t�xr[r �, s” �- r� S F s •t Y; w-. 1 ` ' 3
<br /> �3$P`- 5»'•_ i;
<br /> ,. "sy
<br /> �s
<br /> .s,.p,ty� wa-�a-kt:�#n��'s ;'^:4Fa J•y`7�"r� ��gkf�:�s rrt y� s a - JYj -o �-";fa��`'vk �-,� ; ui
<br /> ��p�ti y"
<br /> rs' "•P,m ii ,i a x. ..a.-M r .td�, Y't2 "i� e a 1 • 4 4 .. y._ .S.Y.3. t 1 k.s 4
<br /> e` 1.'Ott"
<br /> r :t a fi r
<br /> . �1� .1r i I 3. .'sxfi.. CJ" "y ;Q^F "; n !• '2`�'+.5c fr E l- a'�'Y"�.•S
<br /> ��.
<br /> J.
<br /> ate."
<br /> i(Gar'���
<br /> e iIshed b Recew—ed-Fy- } nature _ DatelTime ;
<br /> �c+t•+� ` r�r% �'i-"�`;r�Rl�ss�'s�' ��£�Y�Y- '��,�„ ?z�'y`�,,.,i ti + s'r� ��'-`I''�i.G t�.k
<br /> Relinquished by (Signature): � � y - �[ Received by (Signature)
<br /> �AM`Y'' �i
<br /> 4''
<br /> Relinquished by (Signature).: ,� T A Received by Mobile Laboratory for held analysis (Signature) Date[Time �
<br /> e '�^a'^ r� t• .r a�`« I`rti`v» 4 r'E'F'
<br /> y- '^s .•:y' , �€�A��".P �'.3r'>'"'�'"r"� y;c:- 4� z : '-= yr f I - r�i.%'Y'` ,�`i°$p A �° "{ '
<br /> Mfj,Dispatched by (Srgnatufe) + r } „ Date[Time Received for Laboratory by R, Date(Time
<br /> Y „xr •iiL� 'Rs strk C� �� r y rY , , "r� .-'t' ';fir �'4iSy"•
<br /> a��"" �
<br /> fiRethod of Shipment �� r � Laboratory flame
<br /> �'S cial Instructions r.Wf 1 hereby authorize the performance of the above indicated worker
<br /> r� r��� 'fix+.
<br /> ,w °a 2- -or..ar�' ,,{}�.�� r k{rr€r"
<br /> , re:r .:�..:. �rai1$.^' z� � ,•.vi,
<br /> 14"��->�'Sa'+"
<br /> ;.eti `�.w�,sr-<tiav�:." e7l � sa r3e� ;y �"'r19 ' �x..fi ..ir 'Z � "
<br /> � e
<br /> tiw,+.�„«*..-�•a -�.n{”i >*raae. '+ ,.. },e• t� a _ ,.w - -r.�.^�yS� '7E' ii
<br /> 1
<br />
|